What was the biggest shock for you when you started your first RN job?

• Managing a full patient assignment?

• Prioritizing when everything seemed urgent?

• Time management?

• Talking with physicians and other healthcare professionals?

• Documentation?

• The emotional responsibility of knowing your patients were depending on you?

Looking back, what do you wish nursing school had prepared you for better? And what advice would you give someone who is about to graduate and begin their first RN position?

I think hearing honest experiences can help prepare future nurses for what the transition from student to practicing RN is really like.

Stop, take a breath, and remember you are a professional who has been getting ready for this moment. Now is the time to gain experience, boost confidence, and show everyone what you are made of.

Here are some practical tips that can help you thrive in your new nursing role.

1. Be a Student (Adopt a Growth Mindset)

Even though you have graduated, you are still a student. You are simply a student with a nursing degree and a nursing license. Nursing is about life-long learning, no matter how many years you have been practicing.

This mindset is key to career longevity, especially for new nurses. With a mindset focused on learning rather than just doing, you will be able to gain confidence and demonstrate your willingness to adapt. It may not be the exact way you learned in school, but does it accomplish the same goal? There are many ways to complete a task, and nursing school prepared you for just one of those ways.

2. Be a Quiet Listener

Listening is a learned skill, and it is sometimes a difficult skill to master. Listening well is the kind of skill that benefits from not just teaching but coaching, which means ongoing, specialized instruction from someone who knows your personal strengths, weaknesses, and, most importantly, your habits.

Listening is not just about hearing the words. It is also about receiving and processing those words so you can respond with confidence and understanding. When listening to colleagues or mentors, ask yourself these simple questions:

• Did they share information that I did not know? If yes, be ready to ask questions to ensure complete understanding. If you are already confident in the topic, listen to what they have to say while keeping your student mindset. You might pick up small tidbits to expand your own knowledge on the subject.

• Do I need to respond? Responding is a vital sign of acknowledgment, and it can help you develop strong professional connections with your colleagues.

3. Be in the Moment (Practice Mindful Nursing)

Let's face it, nurses are busy and can easily be distracted from the tasks at hand, even though we are excellent multi-taskers! Being in the moment is intentional. It means focusing on one thing at a time, paying attention to the emotions you are feeling, and responding instead of reacting.

Make the best of the moment by letting the moment guide you. What cues are you seeing from your patient? Should you hold their hand and let them cry? Should you let them be angry?

How you respond in the moment shows deep compassion and demonstrates value to others. Nursing is not just about clinical knowledge and technical skills. It is about connecting with others and making them feel valued. Nurses have a unique opportunity to focus on empathy, ensuring that the patient feels valued, respected, and comfortable with their care.

4. Be Willing (With Caution)

You are excited, you are eager, and you want to show what you learned in school. Hold on to that eagerness with both confidence and caution.

Volunteer to help with an assignment, offer to help another nurse if they seem overwhelmed, and always be willing to say yes when offered an opportunity to learn. Be willing to set aside your biases and be open to whatever this professional journey brings your way.

However, do not be too willing to do something if that action does not seem right, or if it involves a skill you have not been trained to do. You know your abilities and limitations best, so be willing but always be honest.

5. Be Confident

To build clinical confidence, plan and organize your work ahead of time. If you start your shift by being prepared, you will feel less anxious and be able to stay calm when things do not go as planned, and we all know they won't!

Whatever comes your way, be confident in your ability to manage the situation, and never be afraid to ask for help. Celebrate your little successes:

• Starting an IV on the first attempt

• Finding your way around the unit completely on your own

• Completing all of your charting by the end of the shift

You are mastering the art of nursing, and you need to celebrate those wins. You got this!

6. Be Yourself

You went into nursing to help people, not to be perfect. Let the real you shine. You get scared, you get excited, you make mistakes, you get tired, you ask questions, and, most importantly, you are human!

There is no such thing as a perfect human, so do not try to be a perfect nurse. Just focus on being the best version of yourself that patients and colleagues get to meet. With the right mindset, awareness, and willingness, you will be well on your way to being the nurse you want to be and that your patients truly deserve. Well done!

References and Resources

• How to Become a Better Listener: Harvard Business Publishing

• 5 Essential Skills for Compassionate Care in Nursing: Kirby Bates Associates

• How to be more present: headspace

• Build Confidence as a Nurse: 5 Things to Try on Your Next Shift: RNlessons (domain no longer available)

1. Every Veteran on Your Unit Was Once a Terrified Rookie

The seasoned nurses you're scared of? They were terrified on their first day too. The doctor who's intimidating? They have stories about being green and lost. You're not the first person who has no idea what they're doing — you're the latest in a long line of nurses who figured it out. The fact that you feel underprepared means you actually understand the weight of the work. That's a feature, not a bug.

2. Why "I Don't Know" is Your Most Powerful Phrase

The dangerous new grad isn't the one who asks "is this normal?" five times a shift. It's the one who's afraid to look stupid and pretends to know things they don't. Look up every drug before you give it. Confirm orders out loud. Ask the same question three times if you need to. Your patients will be safer and your preceptor will trust you more, not less.

3. The "One-Skill-a-Shift" Survival Strategy

You can't fix your time management, your charting, your IV skills, your phone communication, your med pass timing, AND your priorities all at once. Pick ONE thing each day. Today: getting through morning meds in under 90 minutes. Tomorrow: catching up on charting before lunch. The week after: handling your first call to a physician without notes. That's how the skill stack actually builds.

4. Why Your Preceptor is Your Most Critical Alliance

Even if they're not your favorite person, even if their teaching style is rough — they hold the keys to your competence and your reputation on the unit. Ask them what their pet peeves are on day one. Ask them how they want to be told you don't understand something. Take feedback without flinching, even when it stings. Bring them coffee occasionally. This is a relationship, not just an orientation.

5. How to Survive the 6-Month Physical and Mental Drain

You'll come home and stare at the wall. You'll cry in your car. You'll forget what you ate. This is normal and temporary. Things that genuinely help: protect ONE day a week where you don't think about nursing, eat real meals on shift even if it's just a granola bar, sleep in bed and not on the couch. The nurses who burn out fastest are the ones who think they should "tough it out" through this stage.

6. Why White-Knuckling It Alone Never Works

You will need someone to text at 3 AM after your first patient death. You will need someone who understands why you're spiraling about a med error that didn't actually hurt anyone. You will need a community of other new grads going through the exact same thing right now. Whether that's a friend from nursing school, an old preceptor, or an online nursing community — find them. Do not try to white-knuckle this alone.

7. You Will Make a Terrifying Mistake; Here’s Why You Must Own It

Sometime in your first year, you'll do something wrong — give a med 30 min late, miss a sign you should have caught, chart the wrong room. The nurses who become great are the ones who report it, learn from it, and don't bury it. The ones who hide mistakes don't last. Your unit's safety culture starts with you.

You're going to be fine. Most of us were. Some of us thrived. Some of us had to switch units twice before we found our fit. All of that is normal.

If you're reading this the night before your first shift — go to bed. The hospital will still be terrifying tomorrow. You don't need to memorize the manual tonight.

Welcome to the profession. We've been waiting for you.

After I went to a med surg unit, assigned 5-6 patients and did well for a while. Acuity levels were rising and my assignments seemd extremely difficult, almost every shift. I never sat down, was always behind and noticed other nurses and tech having time to sit, chart and chat...again, most nights. I walked around for 12-14 hours non-stop and currently have shin splints.

I was in the military and no stranger to hard work...I actually enjoy it. But not when it feels unsafe for me or my patients.  

Most shifts I was overwhelmed and was very vocal about not being able to handle it. I'd felt with senior staffs harassment many times, and also brought it up to leadership. A shift with a charge who snapped at and ignored me when I asked for help, doesn't like me, I'm pretty sure. That's fine, but I don't take lightly being disrespected or retaliated against. One patient was experiencing symptoms mines not comfortable with and not able to give the proper attention to due to my heavy assignment. I had them assessed by MET nurses and they were upgraded.  

My charge was mad I didn't tell her I'd called them. I didn't know I was supposed to. Snapped at me and left. I was behind, informed her at the beginning of the shift, and she interrupted me and belittled me for not saying what I needed and had the most aggressive expression and tone of voice all night.  

Following the upgrade that room was cleaned and turned over quickly and I was given another patient, faster than I'd ever seen on that unit.  

I am slow at charting, and have anxiety, but I am always there for patients and staff, have excellent patient care and care about others! Im a combat veteran and no stranger to hard work or difficult situations. I have noticed though, my assignments are very heavy and it feels personal. I was so taken back by the aggressive reaction to me asking for help...had me in tears more than once, while trying to manage more than I could and much I didn't know how to.  

I'm always behind, and stressed...I feel like I'm a horrible nurse. And I feel so alone there...was making my anxiety worse. I met with upper management to address the aggressive and harassing behavior of several senior staff members and the behavior of my charge that night. One nurse harassed new grads daily, humiliated them in front of patients, demanded perfection in report but left a mess for others. Another charge said to me...I was too dumb or stressed to keep up...I wasn't going to be supported if I made an error.  

I was terminated after (I imagine) the charge was talked to and informed of it as I was getting ready to go into work. I have too many call outs, but an equal amount of occurrences as other nurses do. I was fired though, for my attendance. 

I think it's bc I started to get loud about the mistreatment and bullying there and I kicked a hornets nest. I got stung.  

I am relieved to be out of that toxic environment but scared about my track record as new grads and less than a year under my belt. I can handle stress, but not as a nurse with a team that will leave you when you're asking and needing help, and retaliates against you for doing so. I won't. 

I'm not the only one who felt this from her or saw what happened that night. I feel like I became the scapegoat once I began reporting events. I have a lot of improving to do, have anxiety and PTSD, admittedly. This felt personal though and I won't work with people who treat me like that or who are capable of standing and watching someone struggle and puts patients in danger. 

What do I do now? 

Fast forward a few months later, I accepted a position at a very prestigious hospital in Los Angeles—one that does not offer union representation or overtime, but looks great on a resume.  I was initially very excited to begin and complete my new graduate residency there. However, the stress from constant micromanagement, combined with a death in my family and stress related health issues made it extremely difficult to continue working, and I made the difficult decision to resign. 

At this point, I am questioning whether bedside nursing is the right fit for me and feel unsure about my next steps. Many alternative nursing roles seem to require years of experience, and I am struggling with the idea of starting over as a new graduate at another hospital for the third time. If anyone has insight or advice, I would truly appreciate it. 

Wishing everyone an amazing and abundant year. 

Sincerely,

Rachael 

To begin, I have been an LPN for 3 years with my local hospital. I recently started a new RN position in the NICU and have been there since January. 

My orientation was extended at first by one week, then the next time two weeks and just recently they had pulled me into the office on my fourth week and said that if I am unable to improve by this week, than they would have to let me go. Each week was a different preceptor. 

To rewind, they did make an education plan for me which included goals like time management, prioritization, and critical thinking (I don't want to discredit these goals, but I also understand that these take time to establish....with any new speciality...) 

On top of that, I have had 12-13 different preceptors throughout orientation. Some very kind and some....kind of bullies (This, I never brought up to management). 

Next, these last 3 weeks they had me on nights, then days, then back to nights. Each week I would also have a different preceptor....and I did notice something about every single one of them...

The first day would be going great, I'd ask if they had any feedback/concerns for me and they always said no and I was doing great. Then, they would get pulled in to speak with management and all of a sudden everything changed.....they would begin to nitpick at things that I was doing but then also do the exact same thing. On top of that, they were told my management to never intervene and let me do everything. They sat aside at the nurses station for the majority of the shift unless I needed help. I honestly felt like they were just in place to spy and report back to management. 

Some examples of this would be that my preceptor was sitting in the room with me and told me to make sure to clean off some equipment, I was doing this and then all of a sudden the baby started to cry (as one does) and so I quickly finished cleaning and went to comfort the baby. This got reported to management and fell under the (Prioritization category) My preceptor said that I didn't comfort the baby immediately even though she JUST told me to clean something off. 

Another  (different preceptor) example is I entered a contact room with PPE on but forgot my pen which was right on my computer and two inches away from the threshold, so I grabbed it. This, I will admit was my fault....at the time my preceptor wasn't around but somebody reported this to her. I accepted blame and said I would do better....HOWEVER, I then seen her multiple times enter the babies room on contact without any PPE.....I also didn't want to report this to management because I didn't want to seem like I couldn't take feedback and I was just trying to blame others....so I kept quiet. 

At one point, another preceptor made comments how I wasn't asking or googling a lot of questions (she says that she Googled everything when she started) so I began to try and show her that I was interested in caring and would ask questions about orders......she then reported this to management that I was asking questions that I should know by now....this fell under critical thinking. I quickly learned not to ask questions. 

Fast forward to this week, I'm BEYOND anxious now feeling like I only have three days to prove that I do belong here. This first shift I was making SO MANY mistakes such as forgetting a BP on one baby, forgetting to start a feed on an NG tube, etc, I knew I was done for and so at the end of my shift I had met with management and told them I don't think this was a good fit for me.....I am sure that this was not what they wanted to hear, but I feel like I had no other option.....I didn't want to be let go. 

I am so depressed and discouraged because I loved the babies.....maybe I belong somewhere else though. I am currently on personal leave with work and asked management if they knew of any other units hiring (they said I would just have to apply....which I know isn't true because not all units have a job posted but do have open positions and it would just take a simple email to ask) 

Is this normal for orientation? I would think that if I was lacking on time management would it not be beneficial to come into the room and see WHY I am falling behind? Instead of ideally sitting aside. 

I tried voicing my concerns to management (I think she didn't like this) like flipping from days, to nights, having a new preceptor every single week, and on top of that a new team every single shift ("to gain experience"). I felt like it wasn't conducive to my learning and I was set up for failure. 

Any thoughts on all of this? I feel sad and lost...

Looking to relocate to Houston since I haven't found a job for a year here. Any tips? Which hospitals to look into? Which ones to avoid? Are there hospitals that will hire new grad without necessarily a "residency" program?

I accepted an offer for Cleveland Clinic as a New Grad. I finished my RN program while doing pediatric home care with mostly trach/vent patients. I am trying to figure out what the assessment includes so I know what to expect and what kind of info I need to review. I've already looked at the math practice, which is easy, but Im not really sure what to expect with the Success Navigator. I don't expect to be told the exact situations, of course, but any info about what its like and to guide me in the right direction would be appreciated.

The only info I have about it is that I will watch a video showing a patient with a change in status, then chat with an artificial intelligence program that asks what the primary problem is, what clinical observations support your conclusion about the problem, and what actions will you take? 

I was just wondering if there is anyone on here starting the new grad program at kern medical in Bakersfield, CA? If so what unit were you hired into? Excited to start! 

I am a new nurse and accepted a job in the ER. The bad thing is that I was fired before my 90 days was up. What if I apply to another job and don't put this job on my resume. Will it come up on my record?

I'd love any advice for new grads going into an interview like this — how you prepped, what helped you feel more confident, or anything you wish you had done differently.

Thanks!

application status is "Under consideration" after receiving the on demand interview link

I am currently in an accelerated BSN program that will finish at the end of the month. I am thinking of doing a year of service before I enter clinical practice, and I wanted to hear people's thoughts. My main question is, would this affect hiring opportunities the next year if I do not enter clinical practice immediately? How would this look to hiring managers and people involved in hiring decisions?

I would still take the NCLEX as soon as possible in August or September, depending on when my school gives the authorization to test. I would then apply for jobs/nursing residencies in March or April of next year and hope to start working in July or August of the same year.

For the year of service, I would be working with a group that addresses poverty and homelessness. It is a relationship-first model that helps increase the self-esteem and self-efficacy of people experiencing homelessness. As a volunteer, I have personally met and seen people impacted who get into housing, go sober, and reconnect with estranged family because of this.

Here are some of the benefits I think this would give me: 

• resilience and adaptability in the face of adversity 
• people skills like de-escalation and situational awareness
• a broader and more compassionate view of marginalized groups, as a lot of people experiencing homelessness are immigrants, have mental illnesses, etc.

Do you think this is a good idea? Or do you think I would be putting myself at a disadvantage for the future? Would it be better with certain specialties/floors? If this makes a difference, I am a man in my early 20s.

 I have a hard time when coworkers cut corners, and when I speak up about it, it sometimes creates tension between me and management.

I've been an LVN for about 11 months, mostly in LTC. I'm often told I'm a wonderful nurse, but my thoroughness seems to make me "not a fit" for some facilities that prefer speed over accuracy. I eventually went PRN after being pushed out, and later the ADON was told not to let me pick up shifts.

The DON even started a rumor that I had called the state after I reported a documentation issue involving insulin administration. I followed the chain of command, but I was still let go and told to try a sister facility. The new facility initially welcomed me and promised full-time work, but when staffing problems grew, I was told to either take on more shifts or go back PRN.

I reached out to corporate to bring attention to the staff shortages and low retention rates, particularly related to CNA and Medication Aide wages. I even offered a proposal with suggestions for improvement. The day after I sent the email, the DON of the new facility — whom I genuinely liked — resigned.

Since then, I've tried to find work outside this company at other LTC facilities, but my job offers keep getting withdrawn. I've also found that hospitals and schools in my area no longer hire LVNs. The jobs that are available are mostly in LTC or home health — but home health doesn't pay well, and LTC can be very demanding.

Did I ruin my career? Or is there a way to recover from this and find a better fit? Any advice or encouragement would mean a lot right now.

Officials say a nursing home employee was neglectful when she gave a patient 20 times the amount of morphine he was prescribed, leading to his death.

According to a report filed by the Minnesota Department of Health (MDH), a nurse at the Minnesota Veterans Home admitted to giving a patient 100mg of morphine, as opposed to the 5mg he was prescribed, resulting in the patient's death. 

The report states that an employee asked the perpetrator to help give the patient morphine, as she was unsure what to do.

The perpetrator then drew up five 1ml full syringes and gave the liquid morphine to the patient, the report said. According to investigation records, the perpetrator said she thought she knew the order, "that 5mg was the same as 5ml and miscalculated the dose.”

………..

This is why your faculty hacks on you so hard for med math and pharmacology. When you hear somebody say, "it's all unit dose / controlled by the pump / in the Pyxis / set up by the pharmacist / etc., etc.” you can remember this one. (5cc does NOT equal 5 mg. …)

I was hired at my local hospital's Neonatal Intensive Care Unit (NICU) in a rotating position. While I anticipated some growing pains, I was incredibly eager to begin my career.

The Unexpected Challenge

Throughout nursing school and via social media, I had heard the classic warnings about the first year of nursing:

• It is likely to be one of your toughest years.

• Nurses "eat their young."

• You will battle intense imposter syndrome and feelings of incompetence.

• Managing multiple critical patients at once is overwhelming.

I expected these clinical hurdles to be difficult. However, the true challenge I didn't see coming, and what I have struggled with the most, was figuring out how to balance life with working 13-hour shifts. No one seemed to be talking about this. I felt isolated, confused, and began questioning if my struggles meant I wasn't cut out for nursing. I had no qualms about the job itself; in fact, I absolutely love what I do. I was just struggling to maintain my own identity alongside it.

The Self-Care Paradox

At work, online, and in school, talk of self-care was abundant. But who actually has time for self-care when your hard-earned days off are entirely consumed by errands, cleaning, cooking, and trying to squeeze in time for friends and family? Most days, all I really wanted to do was shut my bedroom door and escape into blackout-curtain heaven to sleep.

Compounding the issue were mandated extra shifts and constant text messages broadcasting unit needs, which constantly fogged up my brain on my days off. I had imagined myself re-investing time into the hobbies I lost during nursing school, yet I felt right back in the thick of it, running out of hours in the day.

When I worked night shifts, the struggle amplified. A single shift seemed to swallow two full days: one day spent sleeping before the shift, and another day sleeping after it. Combined with barely getting outside, my mental health hit an all-time low.

Finding Solidarity on the "Struggle Bus"

Fortunately, I connected with a coworker hired around the same time and discovered she was feeling the exact same way. It may sound dramatic, but realizing I wasn't alone felt like finally taking a breath of fresh air. We later found out that another newly hired nurse shared these feelings too; she ultimately decided to transition to a Monday through Friday position with weekends and holidays off.

I can't help but wonder how many other new graduates are out there silently navigating this. I wish I had known about this reality sooner so I wouldn't have spent so much time doubting myself and the career path I chose.

If you are currently encountering this or have gone through it, please know you are not alone on the struggle bus. This specific challenge might not be as overtly obvious as a nurse bullying another colleague or getting yelled at by a physician, but that doesn't make it any less valid.

5 Survival Tips for the First Year

Here are the strategies that have helped me begin to balance the teeter-totter between work and real life (though it is absolutely a work in progress):

1. Drop the Sleep Guilt: Seriously. The cleaning and chores can wait. Say no to social plans if you need to. It is infinitely better to decline an invitation than to show up grumpy and sleep-deprived, trust me, I learned this the hard way.

2. Over-Communicate with Your Circle: Tell your friends and family exactly how you are feeling. Explain that you might not be as available as you'd like to be while your body and mind adjust to a demanding new schedule.

3. Micro-Dose the Outdoors: You don't need to commit to a rigorous 30-minute daily walk. Keep it simple: when you walk to the mailbox, take one extra minute to soak in the sun, breathe deeply, and just exist outside. This has been foundational for my mental health.

4. Ruthlessly Prioritize Your To-Do List: A massive checklist on your days off can feel insurmountable, especially if you only have 1 or 2 days between a block of shifts. Rank your tasks by necessity. For example: groceries always take priority over vacuuming. Being hangry is not the goal here! Choose one critical chore and one self-care activity or hobby to focus on per day to prevent getting overwhelmed.

5. Speak Up to Leadership: Talk to your manager or staff scheduler if your roster is destroying your mental health. I realized a huge part of my isolation was due to working consecutive partial weekends on top of my regularly scheduled weekend shifts. Don't be afraid to voice your needs, and do not feel guilty for doing so. You have to care for yourself before you can properly care for your patients.

Moving Forward

In the meantime, I am heavily focusing on mastering the skill of napping, as I'm quickly learning it is a baseline necessity for survival.

Finally, I have to give a massive shoutout to the nurses who are also parents: in my short time on the floor, I have realized your true title is superhero. I am utterly amazed by your ability to balance it all.

If you have navigated the first-year transition or have any scheduling and lifestyle tips to add, please share them in the comments below!